• Dental caries is a multifactorial, biofilm and pH mediated transmissible disease that affects
people of all ages and disproportionally affects certain populations at epidemic proportions.
• Simply restoring cavitated teeth does nothing to resolve the disease.
• Diagnosis = DETECTION
o the earlier, the better
o visual, sharp explorer, radiograph
• Etiology
o acid-producing bacteria
• Prevention
o plaque removal and diet
• Treatment
o RESTORE cavitated lesions
o WATCH non-cavitated lesions
E. Hewlett - Caries
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• Balance/Imbalance
• “A formalized process that involves an analysis of the probability that the number, size, or
activity of lesions will change over a specified period of time.” (Young, Fontana, & Wolff 2010)
CRA Systems
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• Enamel white spots – why they matter and what to do about them
Sandwich Technique
• Use composite resin and glass ionomer TOGETHER in large posterior direct restorations to…
- Eliminate post-op sensitivity caused by shrinkage and local gaps in dentin-resin interface
- Improve seal at margins lacking enamel
- Reduce restoration placement time
• Use composite resin and glass ionomer as FUNCTIONALLY-COMPATIBLE ANALOGUES for enamel
and dentin
- Replace DENTIN with GLASS IONOMER
- No etching → no potential for incomplete resin seal
- Eliminates technique sensitivity of resin-dentin bonding
- Chemical bond to dentin → high affinity for dentin surface
- No shrinkage stress on interface
- Fluoride release
- Resistance to microleakage on dentin BETTER than resin bonding
- BULK PLACEMENT → eliminates time-consuming incremental layering in large cavities
- Replace ENAMEL with COMPOSITE RESIN
- Occlusal and proximal wear resistance
- Translucency/esthetic
- Best restorative seal on etched enamel
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• “Partial caries removal is…preferable to complete caries removal in the deep lesion, in order to reduce
the risk of carious exposure.”
- D. Ricketts, et al. Cochrane Database of Systematic Reviews 2006, Issue 3. Art. No.:
CD003808. DOI: 10.1002/14651858.CD003808.pub2
• “There is substantial evidence that removing all vestiges of infected dentin from lesions approaching
the pulp is not required for caries management.”
- V. Thompson, et al. Treatment of Deep Carious Lesions by Complete Excavation or
Partial Removal: A critical review. JADA 2008 (139:705-712)
References
Campus G, Cagetti MG, Sale S, Carta G, Lingstrom P. Cariogram validity in schoolchildren: a two-year
follow-up study. Caries Res 2012;46(1):16-22
Domejean S, White JM, Featherstone JD. Validation of the CDA CAMBRA caries risk assessment–a
six-year retrospective study. J Calif Dent Assoc 2011;39(10):709-15.
Hurlbutt M and Douglas DA. A best practices approach to caries management. J Evid Based Dent
Pract. 2014 Jun;14 Suppl:77-86
Maltz M, Garcia R, et al. Randomized trial of partial vs. stepwise caries removal: 3-year follow-up. J
Dent Res. 2012 Nov;91(11):1026-31.
Mertz-Fairhurst EJ1, Curtis JW Jr, Ergle JW, Rueggeberg FA, Adair SM. Ultraconservative and
cariostatic sealed restorations: results at year 10. J Am Dent Assoc. 1998 Jan;129(1):55-66.
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Ricketts DN, Kidd EA, Innes N, Clarkson J. Complete or ultraconservative removal of decayed tissue
in unfilled teeth. Cochrane Database Syst Rev. 2006 Jul 19;(3):CD003808.
Thompson V, Craig RG, Curro FA, Green WS, Ship JA. Thompson V, Craig RG, Curro FA, Green WS,
Ship JA. J Am Dent Assoc. 2008 Jun;139(6):705-12.
Yoon RK, Smaldone AM, Edelstein BL. Early childhood caries screening tools: a comparison of four
approaches. J Am Dent Assoc 2012;143(7):756-63.
Young DA, Featherstone JD. Caries management by risk assessment. Community Dent Oral
Epidemiol. 2013 Feb;41(1)
Young DA, Fontana M, Wolff MS. Current Concepts in Cariology. Dental Clinics of North America, Vol
54(3), July 2010
ehewlett@dentistry.ucla.edu